What's next if all antibiotics fail?

It must have seemed like a miracle when the first commercial antibiotic killed gram-positive cocci in the 1930s. In the 80 years since, antibiotics themselves are starting to die. What comes next is a topic of much discussion.

It must have seemed like a miracle when the first commercially produced antibiotic killed gram-positive cocci in the 1930s. In the 80 years since, antibiotics themselves have hit some bumpy challenges and are themselves starting to die in terms of effectiveness.

What will happen if antibiotics can no longer tackle bacteria is a hot topic in the New York Times opinion page's "Room for Debate."

It's a real and well-documented issue. The Centers for Disease Control and Prevention says "antibiotic use has been beneficial and, when prescribed and taken correctly, their value in patient care is enormous. However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective. People infected with antimicrobial-resistant organisms are more likely to have longer, more expensive hospital stays, and may be more likely to die as a result of the infection."

The CDC notes, among other things, increasing incidence of a dangerous type of staph in communities around the globe, likelihood that antibiotic use in agriculture has created spread of resistant bacteria to people through their food supply, the presence of multi-drug resistant bacteria in hospitals across America and resistance to antibiotics used to treat a growing number of conditions, from malaria to certain fungi.

As for the discussion in the New York Times, several experts offer a variety of analyses.

"Resistance is increasing worldwide, but particularly in low- and middle-income countries. An estimated 60,000 children in India die each year before the age of one month of infections caused by drug resistant pathogens. Nevertheless, many more children die due to lack of access to simple antibiotics than the numbers who die of untreatable infections," writes Ramanan Laxminarayan, who directs the Center for Disease Dynamics, Economics & Policy and is a scholar at Princeton University. He believes the world needs to unite behind global policies, as it has with fisheries.

John Barlett, a professor at Johns Hopkins University School of Medicine, believes the United States has several tasks before it if things are to change.

"The problem will increase unless the United States adopts a national antibiotic resistance plan to deal the all the complex elements: agriculture, antibiotic overuse, infection control, consumer expectations, the pharmaceutical industry, microbiology, regulatory agencies, health care payers and medical practitioners," he writes.

It's a task that Europe has undertaken, with some noteworthy results, Barlett notes.

Others recommend other ways to attack what most agree is becoming a serious crisis. New and effective antibiotics should be developed, argues Brad Spellberg, a professor at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, but the current costs of bringing medication to market are prohibitive when one considers how little money is derived from antibiotics. He explores the idea of "push incentives" to spur development.

One expert points to the need to educate a public that wants "something" to show for a visit to the doctor, even if it's a prescription for an antibiotic that won't work against a cold virus, for instance, but is given anyway. Others note that use of antibiotics in the agriculture industry plays a role that has to be handled.

In 2010, the American Medical Association launched a three-pronged campaign to curb the dangerous overuse of antibiotics. To battle antibiotic resistance, it proposed preserving the ability of antibiotics to kill target bacteria by curbing their inappropriate use, creating incentives to create new antibiotics and coming up with different interventions "to reduce dependence on antibiotics."